Sarah Richardson, CIO, NCH Healthcare System, Chapter 3

When you’re the new CIO, the first few months can be a big adjustment period, but the key, according to Sarah Richardson, is to listen. “You talk to everybody and ask a million questions and listen.” For Richardson, who joined NCH as CIO last fall, this strategy has paid off in the past, and continues to be pivotal in becoming part of the leadership team. In this interview, Richardson talks about how her experiences in the not-for-profit and corporate IT worlds helped prepare her for her current role; what she’s learned about how to build a strong team and keep staff motivated; and how to determine when it’s time to move on. She also discusses the benefits of being a fully outsourced IT shop, her team’s strong focus on population health and patient engagement, and why volunteering is so important to her.

I said, ‘Okay, if being number two’s good enough, then sure.’ That’s all I had to say. They figured out how to be number one and still get the other things done. You just have to meet people where they are.

That’s an unsung hero. Nobody in the entire hospital system is going to know or necessarily care why he was there, because it’s a backend system. It’s keeping the lights on.

You spend the first 60 to 90 days trying to figure out what your burning imperatives are; what’s really broken or what needs to be addressed right now. And you sit back and really listen. You talk to everybody and you ask a million questions and you just listen.

I remember sitting there thinking, this is awesome. This is exactly what you strive to have. But I also knew it was time to move on, because I’d done what I’d set out to do there.

It’s so rewarding to be able to say, I’m in a position that allows me to have a voice. I’m in a community that supports philanthropy. I’m in a hospital that is all about philanthropy, and here’s how I get to be a part of that — at work, at home, everywhere.

Richardson: We created the most awesome team at Mid-America. We were last place on some of our key monthly operating report metrics. I remember I had the coolest boss at HCA. When we weren’t doing well on a metric, he would take a picture of it on his cell phone from his screen and he’d send me a text saying, ‘Awesome job on X.’ And he’d send me one of those funny faces, because he knew I’d be motivated by doing well. I remember coming into the staff meeting and saying, ‘Okay, here’s the text we just got from our boss. We’re in last place on this metric,’ and everyone was like, ‘Oh.’ And so you kind of get that pride going. And I’d say, ‘How can we get to first? At our own capacity, how do we get to number one?’

Because there were 14 divisions in HCA, and so it was very much co-opetition — cooperative competition. I said, ‘What’s everybody else doing that’s making them be so good, and what are we missing?’ And so we just literally figured out, one at time, how do we get to number one here? How do we get to number one here? And every one of my teams in a couple of areas said, ‘Is number two good enough?’ I said, ‘What do you mean?’ And they said, ‘Well, if we’re number two on these two metrics over here, then we can do these other projects we want to do that we think are more important than just being number one over here.’ And I said, ‘Okay, if being number two’s good enough, then sure.’ That’s all I had to say. They figured out how to be number one and still get the other things done. You just have to meet people where they are.

And again, it came down to making people feel like they could do things they never even envisioned or thought possible before, and we’re doing it here. This team is starting to do some really cool things that they didn’t have time for before. We’ve just been evaluating the work differently. I’ll say, okay, why are we doing it this way or what do you really want to be doing and how can we make this happen? And we’re continuing to see progress here as well. Here’s what’s funny — it’s not magic, and it’s not even formulaic. It’s just the right thing to do.

Gamble: It’s really interesting when you talk about having people that you know are very bright and hard workers, but they’re not reaching their full potential. Getting them to that point is something that can seem so insurmountable, but it seems like you have to almost take it on a case-by-case basis and realize it has to be a gradual thing.

Richardson: Yeah. The other thing is recognition. One of my systems guys was here from 8 a.m. till 1 a.m. the other day. Luckily his manager told him to work from home. But he had a configuration he wanted to get done, and we had a couple of things just occur. When he came in the day after, I’d written him a handwritten thank you card and I put a $5 Tropical Smoothie gift card in there. It was a way of saying, thank you for working a 16-hour unsolicited shift. Thank you for making sure that we didn’t have to worry about that one system because you wanted to make sure it was perfect. We needed to get it done, but he made sure it happened. That’s an unsung hero. Nobody in the entire hospital system is going to know or necessarily care why he was there, because it’s a backend system. It’s keeping the lights on, but it showed his dedication to making sure that happened. He’s a new guy on our team. And he wasn’t doing it for the glory — he was doing it because he was like, I’m only dealing with something once and then I’m moving on to the next project. I’m not going to spend five days messing around with something when I know if I just if I sit down and do it, it gets done. Wow. To have that kind of team member is unique and special and should be rewarded.

Gamble: Something like that really does go a long way.

Richardson: Yeah, because otherwise there’s no incentive for him to want to work that hard. I don’t expect him to be here 8 a.m. to 1 a.m. every day, but I know if I’m going to be in a foxhole somewhere or in a fire fight, I already know I want that guy with me in that situation.

Gamble: Absolutely. When you were at Mid-America, you said there were some really great people, but they were working in silos. What would you say are some of the early steps to reversing that or just trying to take that in a different direction?

Richardson: I took a pretty hard-line approach. I’m not sure it was necessarily appreciated in the beginning, but when I got there, I already knew that probably 50 percent of the people on the leadership team were not in the right seats on the bus. When you first get to an organization, you just listen. You spend the first 60 to 90 days trying to figure out what your burning imperatives are; what’s really broken or what needs to be addressed right now. But otherwise, you sit back and you really just listen. You talk to everybody and you ask a million questions and you just listen.

Luckily, I’d already been with HCA for about six years at that point, and so I knew the reputation of the team and what I was walking into. It wasn’t a blind, brand new assignment. So when I got there, I actually took our vice president of organizational development who is an organizational psychologist and brought her in to some team building events. And she knew the back story. I told her I already had a sense of things, and she said, ‘don’t tell me who you think shouldn’t be here. Let’s do a couple days of off-sites and team building and see where things land.’ And she would do things like the Myers-Briggs or a trust survey and look at how good are we as a team and do self-evaluations to see how people responded and what the feedback would be. And after two days, those people had already identified themselves without our having to even go through extra detail. It was like, there’s the insolent one in the corner. There’s the one who’s on their laptop and won’t pay attention. Here’s the one that’s trying to control the environment. Here’s the one who just burst into tears and is bringing up 20 years of history. I said, ‘you just identified the team that needs to go.’

The trick, at that point, was when. In some cases you’re going to let all four people or five people go at the same time. But other times you’re like, wow, I can’t just slash the whole team, because a) that doesn’t foster anything, and b) I still need some of these people to help me build. And not everyone was a lost cause. You might think they’re on the fence; let’s coach them, and within a few months, we’re going to coach them up or out of the organization. And honestly, it probably took about 14 months to weed out the team members that really shouldn’t be at the leadership table and to start to hire the right personalities for the table.

After 18 months, I felt like I was 90 percent there. I had exactly who I wanted, and I had to start building on how we were going to perform, and then we could merge the two divisions. I literally had to start all over again, and that was okay, because we had just done it. And, again, we made a lot of decisions and a lot of changes. Funny enough, at the end of all it I was at year four and I thought, I have the perfect team. We did monthly off-sites, because I think it’s important to get out of the office and just think and work on your strategic and key operational initiatives together. I remember sitting there thinking, this is awesome. This is exactly what you strive to have. But I also personally knew it was time to move on, because I’d done what I’d set out to do there. I had a successor in place. I had this high-functioning amazing team, and I thought, my work here is done.

And that’s when I started to look for what was next for me. So you build this perfect team and then it’s time to move on, so it was sort of bittersweet in the realization that I already knew that was my long-term plan at that point. A team and an organization should be better after you leave, because you created that environment — and they are. They’re doing the most amazing things in that division. I’m still in touch with a lot of them and just so proud of them because they continue to believe in themselves and do fantastic work and they have the perfect replacement for me. He’s this really dynamic, really energetic guy that was exactly what they needed next. So it’s just fun to be able to say, hey, that’s the way it’s supposed to go, and it worked. It was the right mix.

Gamble: Absolutely, and it seems like you definitely found the right landing spot.

Richardson: A lot of times people go into their career and they say, I’m going to do this for 20 years, and they’re perfectly okay with that, and that’s wonderful. When you make plans for your career, you make plans for your life, and most of the time it happens that way, but you never quite know what’s going to come at you. If you told me a year ago I wouldn’t be working for my previous company and I’d be living in Florida, I would have said, ‘Really?’ And yet, once I made the decision, it all fell into place. And so I think as long as you have multiple contingency plans, you’re always going to land on your feet.

Gamble: That’s great. The last thing I wanted to ask you about was volunteer work. I saw it on your LinkedIn page. I have a lot of respect for people who have the intense workload and life of a CIO and are able to carve out time for volunteer work, and I just wanted to talk about how that does benefit you.

Richardson: Really the most important thing you can do is to be in a place of security or means of any kind. And when I say that I think about Maslow’s Hierarchy of Needs. You can come to work every day and make a difference, and then the next thing you think about is how do you give back? It’s something that’s always been important. That’s how I was raised, but it’s always been something important to me in my career.

And even here, I came to Naples with a really specific plan to say, these are the three organizations — well, two at the time and now a third — that I really want to be involved in. I’m going to spend 90 days getting settled at work and then I’m going to join these organizations, and I’ve already done that. I’m aligned with Big Brothers/Big Sisters, Wounded Warriors and the shelter for abused women and children here in Naples. And I’m so excited because I just met with the Wounded Warriors guys the other day and they said, ‘Yeah, we need you. We need your help.’ To me it was, I get to check that box that I am involved exactly in the three areas that I want to be involved in from a philanthropy perspective here at the hospital, and it’s so rewarding. It’s so rewarding to be able to say, I’m in a position that allows me to have a voice. I’m in a community that supports philanthropy. I’m in a hospital that is all about philanthropy, and here’s how I get to be a part of that — at work, at home, everywhere.

HCA was very much that way, too. I think that you go and you work for companies that have the same values you do. HCA was amazing with philanthropy and caring for the community, and they really instilled that. They gave you time off to do volunteer work and had huge company initiatives around caring for the community. I’ve always worked in an environment where that was a true statement. If you’re passionate about something and it can make a difference, then you have to give back. You have to find opportunities to give back. And so if there is something that’s specifically important to you — animals, women, children, warriors, whatever it is — go after it. There are so many 501(3)(c)s out there that need support and need help. You can use CharityNavigator.org — it’s my favorite way to determine if a charity is doing the things that they’re supposed to do. And go out there and give back.

A lot of people say, I don’t have any money to give. Well then, give time. And it doesn’t have to be a lot of time. At the shelter, for example, they need people to go out and give speeches about the shelter to different groups, so I joined their speaker bureau series. Now when the shelter needs somebody to talk about their programs, they send me. I can go talk to a Rotary club. I can go talk to a high school. I can go talk at a business meeting for an organization and do what I call the five, 10, 15, or 30-minute version of what the shelter brings to the community. It’s just really awesome to be able to figure out how your skill set fits into an organization. And it doesn’t have to be about monetary donations — sure, that’s great, but the best resource you can give to most organizations is dedicated time.

Gamble: That’s great. It’s really good to hear, and to give those resources out is really helpful too, because I think for a lot of people it’s on their mind. It’s something that they want to do, but it’s a matter of just getting that push and saying that you can find the time and make it part of your job.

Richardson: And a lot of places are open to families doing that. So it’s just me and my boyfriend and we don’t always have a lot of time together, so we try to align our charity work together. It’s like, hey, it’s Saturday — what do you want to do? Well, we’re going to go volunteer over here. We’re going to do a 5K donated to this organization. But it’s time together, so you combine your civic, your social, your philanthropy — all these ports of life together, and you do it together. A lot of them will even allow families to participate, so incorporating it into your lifestyle isn’t as hard. I would say just, start small. If you start huge, you’re probably going to fail — it’s like a diet. Start with small incremental things that make a difference, and you’d be surprised at how much time you find. But the reward that’s attached to it — it feels really good to be able to do something for others.

Gamble: Yeah, definitely. Alright, well that covers everything I wanted to talk about. I really appreciate your time and I love your energy. I think it’s very inspiring and it’s great to hear, and I think hearing about your experiences will be really beneficial to our audience. So thank you so much, I appreciate it.

Richardson: Thank you for your time, and I definitely would love to connect with you at HIMSS and CHIME. I look forward to meeting you in person in the future, and I appreciate the time that you took.